The Expression And Meaning Of ESM-1 In Sepsis

Sepsis remains one of the most common causes of hospitalization and death in intensive care units.Despite the breakthrough in treatment.the mortality remains high.Therefore,early diagnosis and evaluation of the severity and prognosis of sepsis is particularly important in the comprehensive treatment of sepsis.Endothelial cell-specific molecule-1,ESM-l.endocan,a proteoglycan secreted by endothelial cells,has been found to play an important role in the genesis and development of sepsis.It is mainly expressed in the endothelial cells of the lungs and kidneys.Under the stimulation of inflammatory factors,the expression of endothelial cell-specific molecule-1 increased obviously,and could reflect the degree of activation and damage of endothelial cells.In addition,the level of endocan was correlated with severity.organ dysfunction and prognosis of septic patients.Therefore,early detection of endocan levels may be of great value for the diagnosis,treatment,and evaluation of sepsis in the future.ObjectiveThe purpose of this study was to evaluate the diagnostic value of endocan by comparing the levels of procalcitonin.C-reactive protein(CRP)and endocan of septic patients and normal person.The severity indexes of septic patients were recorded,the APACHE ? score and SOFA score were calculated,and the correlation between the severity of sepsis and endocan by comparing with the level of endocan.The death of the patients on the 10th and 28th day were observed and recorded.The relationship between the endocan level on admission and the prognosis of sepsis patients was evaluated by comparing the death group and the survival group,comparing the level of endocan with the APACHE ? score and the SOFA score.Method1.This study was conducted in the intensive care unit of a university affiliated hospital and included 60 septic patients and 14 healthy volunteers.Blood was collected and centrifuged,extract the supernatant and store it at-20? or-80? until measured.2.Plasma endocan level was measured by mlbo@ ELISA(enzyme linked immunosorbent assay).3.Patients' age,gender,diagnosis,the 10th mortality,the 28th mortality,acute physiology and chronic health scores(APACHEII scoring system)and SOFA scores were recorded after the patients were included.Including ICU hospital stay,treatment,pulmonary imaging,blood routine,and PCT,IL-6,oxygenation index,general clinical data will be recorded each day of the first week after inclusion.4.To mensurate the expression of endocan in septic patients and its connection with the severity and prognosis of the disease.Results1.The plasma endothelial cell-specific molecule-1 level in sepsis group was significantly higher than that in healthy group:9.82ng/ml 5.69-22.42]vs3.29ng/ml[0.49-4.53],p=0.000.2.There was no significant difference in endocan level between septic shock group and non-septic shock group:9.90ng/ml[6.08-20.58]vs9.74ng/ml[5.10-23.56],p=0.762.3.The level of endocan of 10th death group was significantly higher than survival group:18.2 1 ng/ml[16.76-25.16]vs8.65ng/ml[5.34-21.94],p=0.02.4.No significant difference was found in plasma endocan level between the death patients and the survival patients on the 28th day.5.There was a small statistical difference between plasma endothelial cell-specific molecule-1 level and APACHEII score in sepsis patients(p<0.02).but no significant difference with SOFA score(p=0.158),indicating that endothelial cell-specific molecule-1 level was correlated with the severity of the disease to a certain extent.6.ROC curve analysis for endocan differentiating between septic patients and normal person gave an area under the curve(AUC)of 0.890(95%confidence interval[CI]0.812-0.969)compared with 0.849(95%Cl 0.721-0.976)for procalcitonin,0.849(95%Cl 0.721-0.976)for CRP.ROC curve analysis for endocan differentiating between 10th death group and survival group gave an AUC of 0.752(95%Cl 0.627-0.878)compared with 0.627(95%CI 0.431-0.824)for APACHE ? score,0.643(95%CI 0.431-0.855)for SOFA score.ROC curve analysis for endocan differentiating between 28th death group and survival group gave an AUC of 0.644(95%CI 0.495-0.793)compared with 0.644(95%Cl 0.495-0.793)for APACHE ? score,0.489(95%CI 0.325-0.653)for SOFA score?The comparison of the AUC showed that compared with APACHE ? score and SOFA score,endocan had a better prognostic value in predicting the death of patients on the 10th day.ConclusionThese results suggest that the level of endothelial cell-specific molecule-1 in blood is significantly higher in patients with sepsis,which is related to the severity of the disease and the prognosis of the patients,which may be a new marker of endothelial dysfunction.